(1) Signs/symptoms. The infection begins suddenly with rapidly increasing
pain in the affected area, a fall in blood pressure, and tachycardia. The patient
becomes anxious and frightened with a slight fever (less than 101 F) and profuse
sweating. His pulse is elevated (greater than 120 per minute). The wound itself
becomes swollen, and the skin around the wound is pale due to accumulation of fluid
under the skin. The wound has a reddish-brown discharge which is foul-smelling fluid
from the wound. As the infection progresses, the surrounding tissue changes from pale
to dusky and finally becomes deeply discolored with red, fluid-filled sacs. When the skin
surface is lightly touch, gas in the tissues may be felt. Eventually, the patient suffers
severe prostration, stupor, delirium, and coma.
(2) Treatment. Treatment must begin immediately for delay could mean
loss of life. The most important treatment is surgical removal of any dead tissue in the
involved area and airing of the wound. Keep the wound open to drain. Give penicillin
intramuscularly every 3 hours and tetanus toxoid according to local standing operating
procedure. Hyperbaric oxygen therapy may be helpful. The patient is placed in a
hyperbaric chamber, a room which contains oxygen at a concentration and pressure
much higher than the normal atmosphere. The patient's bloodstream and tissues are
saturated with oxygen for one to three hours at a time. Repeat this treatment every six
to eight hours. Manage shock and dehydration if present and evacuate the patient.
e. Tetanus. Caused by the organism Clostridium tetani, tetanus attacks the
central nervous system. The organism is found in the soil and feces of animals and
humans and enters the body through a puncture wound or pus-filled, dead tissue.
Tetanus is an acute, infectious disease caused by the toxin of tetanus bacillus.
(1) Signs/symptoms. The first symptoms may be pain and tingling at the
wound site followed by spasms of the muscles located close to the wound. Usually, the
first symptoms are jaw stiffness, neck stiffness, dysphagia (difficulty swallowing), and
irritability. Minor stimuli can cause painful, long lasting convulsions. During
convulsions, the glottis and respiratory muscles may go into spasm so that the patient
can't breathe, and he may die from lack of oxygen. Throughout the illness, the patient
has only a low grade fever. Contraction of facial muscles may cause the patient's face
to have a mask-like grin (risus sardonicus).
(2) Prophylaxis at time of injury (precautions taken to prevent the disease).
A person who gets a wound and suspects that Clostridium tetani organism might be
present should receive tetanus toxoid immediately. Administer 0.5 cc intramuscularly in
the dosage 25-500 units. The dosage depends on the seriousness of the wound, not on
the age or weight of the patient. Patients who have had tetanus immunizations should
be given a tetanus toxoid booster of 0.5 cc intramuscularly immediately. An exception
can be made if the patient has had a tetanus toxoid booster in the last five years. In the
case of a severe, puncture wound, if the patient has had a tetanus toxoid booster in the
past twelve months, another tetanus booster need not be given.